| NPI | 1902341936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135140) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA IMF95245) | |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2022-11-15 |