| NPI | 1912788282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT160429) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2025-12-29 |