| NPI | 1982206421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 121333) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 8343) |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2024-05-08 |