| NPI | 1588944649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 92395) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 4061) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2025-03-11 |