| NPI | 1407209141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 141124) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 100884) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2023-11-30 |