| NPI | 1609482496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 152769) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2026-05-26 |