| NPI | 1821598020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 73569) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2025-07-28 |