| NPI | 1720593718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 139075) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 103633) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2026-01-04 |