| NPI | 1295581536 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT156933) | 
| Additional Taxonomies | 225400000X Rehabilitation Practitioner | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-04-26 | 
| Last Update Date | 2025-08-05 |