| NPI | 1689071300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136101) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA AMFT108493) |
| 106H00000X Marriage & Family Therapist | |
| 101Y00000X Counselor | |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2024-02-18 |