| NPI | 1104559004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 156216) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: CA 13091) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2025-07-21 |