NPI | 1093130510 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120767) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
Enumeration Date | 2014-02-20 |
Last Update Date | 2020-08-20 |