| NPI | 1588499065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 164039) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 23004) |
| Enumeration Date | 2024-09-04 |
| Last Update Date | 2026-06-24 |