NPI | 1942703715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC19831) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT127180) |
Enumeration Date | 2018-03-17 |
Last Update Date | 2025-08-15 |