| NPI | 1821478710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT124939) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 96794) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: HI H01297245) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-02-20 |