| NPI | 1073064358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 128530) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF 90816) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2021-10-15 |