| NPI | 1528511227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF89959) |
| 101YP2500X Counselor, Professional (Licence: CA PCCI2509) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2020-10-02 |