NPI | 1164784484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 116660) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
Enumeration Date | 2012-06-12 |
Last Update Date | 2024-10-21 |