| NPI | 1376066936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 98030) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 13882) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2024-01-23 |