| NPI | 1912516741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10566) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2022-10-26 |