| NPI | 1740527936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 84684) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 84684) |
| 106H00000X Marriage & Family Therapist (Licence: CA 104490) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2018-02-21 |