| NPI | 1831702463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 133501) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA AMFT133501) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2022-11-29 |