| NPI | 1073942017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 144892) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2024-02-14 |