| NPI | 1356950430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136559) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-03-31 |