| NPI | 1679071450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT103919) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 204141) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2026-03-24 |