| NPI | 1457986226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC12712) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 101075) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2022-12-15 |