| NPI | 1295937621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 94074) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2019-06-24 |