| NPI | 1124513692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 121211) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-08-29 |