| NPI | 1245662519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122758) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF83114) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2020-10-29 |