| NPI | 1417638271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 148622) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 17141) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2026-06-30 |