| NPI | 1508619347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LAMFT-9985) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2303) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |