| NPI | 1952650970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136487) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF77966) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2023-01-10 |