| NPI | 1780199729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112297) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2022-01-07 |