| NPI | 1780071894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105218) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LMFT1058218) |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF85521) | |
| 106H00000X Marriage & Family Therapist (Licence: NV 4401-R) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 204245) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-06-27 |