| NPI | 1851925929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA MFT1245) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 8571) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2025-01-14 |