| NPI | 1386185411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA AMFT110202) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 110202) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2022-07-21 |