| NPI | 1861076705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT136147) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT136147) |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2023-07-07 |