| NPI | 1932654258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 149090) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2025-04-09 |