| NPI | 1417003807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT49368) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA IMF 40986) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-11-13 |