| NPI | 1336669522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 100941) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist (Licence: CA 100941) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |