| NPI | 1972097822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140184) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 17993) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-06-18 |