| NPI | 1407908684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48264) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OR T3136) |
| 101YM0800X Counselor, Mental Health (Licence: WA 00010938) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2026-05-13 |