| NPI | 1912380437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122399) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 1912380437) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2020-10-13 |