| NPI | 1710690284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 123794) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 9135) |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2022-12-29 |