| NPI | 1912497272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143160) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT115767) |
| 106H00000X Marriage & Family Therapist (Licence: CA 115767) | |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2023-12-04 |