| NPI | 1851882633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 132241) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 118020) |
| 101YM0800X Counselor, Mental Health (Licence: CA 118020) | |
| 101YM0800X Counselor, Mental Health (Licence: CA 7554) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2023-03-15 |