| NPI | 1902205347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144562) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA AMFT109264) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2024-01-24 |