| NPI | 1912614652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT164828) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT136911) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2026-08-20 |