| 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 |