| NPI | 1497538508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152431) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 18471) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2025-05-27 |