| NPI | 1588316137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT139087) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA AMFT139087) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2023-07-10 |