| NPI | 1700407160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 7782) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 120755) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2022-08-31 |