| NPI | 1942048152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT161053) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC21709) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2026-01-25 |