| NPI | 1801511399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136322) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 104100000X Social Worker | |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-01-02 |