| NPI | 1891398418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 95923) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 95923) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2021-12-16 |