| NPI | 1780368126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 162277) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-05-13 |