| NPI | 1336751882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131575) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 11829) |
| 101YM0800X Counselor, Mental Health (Licence: CA 11829) | |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2024-03-28 |