| NPI | 1972479400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 161531) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 21886) |
| 171400000X Health & Wellness Coach (Licence: CA 297077F429) | |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2026-03-20 |