| NPI | 1801108469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 105061) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 2376) |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2023-11-28 |