| NPI | 1740412147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 58574) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 58574) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2012-11-30 |