| NPI | 1649008798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 148130) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 16723) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-22 |