| NPI | 1902421928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 142661) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-11-06 |