| NPI | 1578261608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT138473) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-03-24 |