| NPI | 1194440131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT137195) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT137195) |
| 101YP2500X Counselor, Professional (Licence: CA APCC12788) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2024-04-26 |