| NPI | 1558617977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 82563) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: 82563) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2018-01-08 |