| NPI | 1346617537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 96131) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2019-06-25 |