| NPI | 1740665025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 106H00000X) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2023-10-20 |