| NPI | 1740097831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143596) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 15446) |
| Enumeration Date | 2024-12-12 |
| Last Update Date | 2024-12-12 |