| NPI | 1568817591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 115094) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 6913) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2022-05-17 |