| NPI | 1164972691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 145731) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 171M00000X Case Manager/Care Coordinator | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2025-01-16 |