| NPI | 1528191178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 56281) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: CA 080107114) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2019-04-22 |