| NPI | 1578813408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA amft77895) |
| 101YM0800X Counselor, Mental Health | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA IMF77895) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA AMFT117271) | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2022-12-12 |