| NPI | 1689280422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 94369) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 94369) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2022-04-18 |