NPI | 1255567699 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130408) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT110663) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2009-05-29 |
Last Update Date | 2024-02-26 |