| NPI | 1447822903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 126109) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-10-01 |