| NPI | 1306344841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 156383) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101Y00000X Counselor | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2026-07-01 |