| NPI | 1912721424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143663) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 15461) |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-12 |