| NPI | 1609925072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT77997) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT11714) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2016-03-24 |