| NPI | 1629625165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 126186) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 12365) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2024-05-17 |