| NPI | 1922420819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120764) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 76793) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2021-05-11 |