| NPI | 1457600074 |
|---|---|
| Former Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF69928) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2023-08-30 |