| NPI | 1174079925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AMFT132838) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA NA) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-06-08 |