| NPI | 1598595548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130795) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 11120) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-20 |