| NPI | 1639881865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 154907) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 0003155) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-04-29 |