| NPI | 1326580531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 124389) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 124389) | |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2024-08-07 |