| NPI | 1750801106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142847) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2024-01-23 |