| NPI | 1770024200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 109422) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA D7427657) |
| 106H00000X Marriage & Family Therapist (Licence: CA 109422) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2021-10-29 |