| NPI | 1801564711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT157901) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT135570) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2025-09-18 |