NPI | 1205380193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 125082) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-08-08 |
Last Update Date | 2022-07-28 |