| NPI | 1720219561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: 42969) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101YM0800X Counselor, Mental Health (Licence: CA 42969) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2025-12-04 |