| NPI | 1700636800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 157432) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0021448) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2026-01-29 |