| NPI | 1710537030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124477) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 124477) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2022-04-13 |