| NPI | 1063195642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT163658) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC15035) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2026-06-10 |