| NPI | 1245421981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 53652) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 52259) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2018-05-25 |