| NPI | 1356637383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT105272) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA E2041515) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2019-07-11 |