| NPI | 1952321119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT 552) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: CA SP 942) |
| 231H00000X Audiologist (Licence: CA Aud 66) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |