| NPI | 1528437902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 12743) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2025-04-08 |