| NPI | 1982201646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 138667) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 110019) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2024-09-18 |