| NPI | 1336673730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 121902) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106H00000X Marriage & Family Therapist (Licence: CA 109501) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2024-01-24 |