| NPI | 1184967101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT123696) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 123696) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-01-05 |