| NPI | 1407490733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT112805) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 112805) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2024-01-05 |