| NPI | 1760955397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT116675) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 116675) |
| 101YM0800X Counselor, Mental Health (Licence: CA 103856) | |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2021-05-14 |