| NPI | 1063666550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 52499) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2024-05-15 |