| NPI | 1093857757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 53770) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 50420) |
| 225400000X Rehabilitation Practitioner (Licence: CA 50420) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-12-27 |