| NPI | 1972526390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LMFT44667) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 44667) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-03-19 |