| NPI | 1578245569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 157327) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: NY 003223-01) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2026-01-30 |