| NPI | 1356677199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 157213) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 114877) |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF76150) | |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2026-01-26 |