| 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 |