| NPI | 1679847578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT120312) |
| Additional Taxonomies | 101Y00000X Counselor |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2020-10-30 |