| NPI | 1407224165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT128785) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPCC9650) |
| 374700000X Technician (Licence: CA PT34493) | |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2026-02-10 |