| NPI | 1639693211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 116141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95675) |
| 106H00000X Marriage & Family Therapist (Licence: CA 95675) | |
| 101Y00000X Counselor (Licence: CA 95675) | |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-07-28 |