| NPI | 1831590884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 110577) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 81152) |
| 101YM0800X Counselor, Mental Health (Licence: CA 110577) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2026-02-10 |