| NPI | 1447597455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105341) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA IMF81700) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2025-05-23 |