| NPI | 1619591336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142711) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 101Y00000X) |
| 101YM0800X Counselor Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-12-21 |