| NPI | 1528494820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128871) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF 78295) | |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2023-01-05 |