| NPI | 1790172955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105378) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 6221) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2025-06-11 |