| NPI | 1033493804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 111223) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2019-03-19 |