| NPI | 1831435783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 106492) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2026-03-26 |