| NPI | 1366904500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 147557) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2024-07-31 |