| NPI | 1922871490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 144301) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT144301) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-03-17 |