| NPI | 1467584268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 45661) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 42788) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-03-02 |