| NPI | 1538656061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 162837) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 128057) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 128057) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2026-04-13 |