| NPI | 1427934736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 164468) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA Y4730854) |
| Enumeration Date | 2025-08-12 |
| Last Update Date | 2026-07-17 |