| NPI | 1366845232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127871) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 123462) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2024-09-10 |