| NPI | 1922431444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA IMF75946) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2016-12-01 |