| NPI | 1710677539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 139409) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 139409) |
| 103TC1900X Psychologist, Counseling (Licence: CA 139409) | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |