| NPI | 1699136978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 121606) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 205685) |
| 106H00000X Marriage & Family Therapist (Licence: KS 03112) | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2025-04-03 |