| NPI | 1790287217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124084) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA MFTI103612) |
| 106H00000X Marriage & Family Therapist (Licence: CA 103612) | |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2022-08-19 |