NPI | 1104582527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129790) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2021-11-10 |
Last Update Date | 2022-06-03 |