| NPI | 1619598760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 143009) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 10491) |
| 106H00000X Marriage & Family Therapist (Licence: CA 128647) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2023-12-18 |