| NPI | 1558964932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 161870) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 22110) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2026-04-10 |