| NPI | 1780367144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12796) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 136277) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2026-02-09 |