| NPI | 1669732285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA imf69537) |
| 225400000X Rehabilitation Practitioner (Licence: CA IMF 69537) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2021-09-20 |