| NPI | 1285229989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 154261) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2025-08-11 |