| NPI | 1275943557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 89410) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA E1273215) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2015-10-09 |