| NPI | 1093114449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 34291) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 36452) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2021-02-09 |