| NPI | 1376630665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130357) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF62390) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-01-04 |