| NPI | 1922562446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 134755) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist (Licence: CA 115700) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2022-10-31 |