| NPI | 1861994238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA LPCC18773) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2025-03-31 |