| NPI | 1922456029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 118391) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 102407) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2020-02-27 |