| NPI | 1821509654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127134) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health (Licence: CA IMF101526) | |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2024-01-22 |