| NPI | 1578058681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120167) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 14914) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2023-10-25 |