| NPI | 1013005511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 42969) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-06-23 |