| NPI | 1669191912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130567) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 11024) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-08-22 |