| NPI | 1164784484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT116660) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF75594) |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT114839) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2023-08-01 |