NPI | 1023137304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT49919) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 49919) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2007-03-28 |
Last Update Date | 2021-11-23 |