| NPI | 1639356165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT Intern 59214) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 106H00000X Marriage & Family Therapist (Licence: CA 89896) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2025-12-02 |