| NPI | 1578083606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT110582) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AMFT110582) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA AMFT110582) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |