| NPI | 1538507694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT88817) |
| 106H00000X Marriage & Family Therapist (Licence: WA 60599604) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2022-07-21 |