| NPI | 1609127554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 85351) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2025-06-04 |