| NPI | 1306491600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA APCC9142) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA APCC9142) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2021-11-16 |