| NPI | 1528805934 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 156115) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 20739) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2026-08-17 |