| NPI | 1174108088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131932) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 331869) |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2023-03-03 |