| NPI | 1013256908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 165572) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2026-09-17 |