| NPI | 1700032547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 131249) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: CA 118034) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-05-07 |