| NPI | 1528506888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT131907) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2022-12-16 |