| NPI | 1831872761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 140698) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 140698) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 508OOS) | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2023-09-13 |