| NPI | 1013402734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 108784) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 5482) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2018-09-05 |