| NPI | 1902925936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 149759) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF54307) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2024-10-16 |