| NPI | 1699321562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 17003) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 127491) |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2025-09-29 |