| NPI | 1114872868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT164880) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2026-02-27 |
| Last Update Date | 2026-08-27 |