| NPI | 1558480731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94027661) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPCC1251) |
| 103TS0200X Psychologist, School (Licence: CA LEP3640) | |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC47346) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2024-07-30 |