| NPI | 1386116259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 109593) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 123129) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2020-11-19 |