| NPI | 1902657869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 139516) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 13859) |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-03-28 |