| NPI | 1720564222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 138676) |
| Additional Taxonomies | 101Y00000X Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 138676) | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2023-07-14 |