| NPI | 1740821727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT130712) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-03-29 |