| NPI | 1639549736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT88029) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: CA 120575046) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2024-01-22 |