| NPI | 1730213737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 53409) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 69517) |
| 225400000X Rehabilitation Practitioner (Licence: CA IMF 50032) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-05-02 |