| NPI | 1710629647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 146926) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ 16403) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-08-06 |