| NPI | 1912421363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 132704) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 132704) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2023-03-27 |