| NPI | 1962987594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT132141) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 118398) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2022-04-20 |