| NPI | 1568194777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 134162) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2024-05-02 |