| NPI | 1619365863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 110273) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 98878) |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2019-01-03 |