| NPI | 1790038149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140453) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 122394) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2023-08-29 |