| NPI | 1376770859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFCC #47549) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC # 221) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2024-06-20 |