NPI | 1316393887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 103536) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2016-05-13 |
Last Update Date | 2024-08-30 |