| NPI | 1740058692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 138074) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 13462) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2024-01-24 |