| NPI | 1649036898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142985) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 15238) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2024-02-26 |