| NPI | 1750948899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 165598) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 23853) |
| 373H00000X Day Training/Habilitation Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2026-09-17 |