| NPI | 1891177259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 137456) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health (Licence: CA 117623) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 117623) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 117623) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2025-05-19 |