| NPI | 1235670407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130732) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PCCI13791) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-03-16 |