| NPI | 1790029528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 90889) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health (Licence: CA 75381) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2016-01-18 |