| NPI | 1033843446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 155806) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2026-04-07 |