| NPI | 1710463260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT158896) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2025-12-03 |