| NPI | 1679006191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152209) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 7416) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-01-22 |