| NPI | 1396049458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 57015) |
| 106H00000X Marriage & Family Therapist (Licence: CA 50481) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 001376) | |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2025-03-05 |