| NPI | 1891177259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 117623) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 117623) |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health (Licence: CA 117623) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-01-21 |