| NPI | 1598874349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 44602) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 44602) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2026-07-27 |