| NPI | 1033239090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA 52214) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 52214) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-02-17 |