| NPI | 1750756110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12550) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 137854) |
| 172V00000X Community Health Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2026-04-13 |