| NPI | 1669861613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 203560) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 77283) |
| 101YM0800X Counselor, Mental Health (Licence: CA 77283) | |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2026-03-16 |