| NPI | 1215300645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMFT0938) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2015-11-06 |