NPI | 1639418585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 102280) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
Enumeration Date | 2013-02-12 |
Last Update Date | 2017-10-03 |