| NPI | 1689292492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135125) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2024-07-16 |