| NPI | 1568161271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 145920) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA J525739950410) |
| Enumeration Date | 2023-03-02 |
| Last Update Date | 2024-03-26 |