| NPI | 1710243019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140187) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 74304) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 112065) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2024-06-27 |