| NPI | 1760955397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T2865) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 103856) |
| 106H00000X Marriage & Family Therapist (Licence: CA 116675) | |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT116675) | |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-12-05 |