| NPI | 1780924803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 119244) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 3211) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2024-04-18 |