| NPI | 1215353735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT87794) |
| 106H00000X Marriage & Family Therapist (Licence: CA 126971) | |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2024-05-22 |