| NPI | 1942703715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127180) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 11023) |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2022-02-09 |