| NPI | 1821560236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 116093) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 116093) |
| Enumeration Date | 2018-12-24 |
| Last Update Date | 2023-11-08 |