| NPI | 1366746059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT126769) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA IMFT 70957) | |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT106334) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA IMF70957) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2021-07-11 |