| NPI | 1619644275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA RAMFT133329) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-08-23 |