| NPI | 1730754144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 20254) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 157359) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2025-10-03 |