| NPI | 1962710996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC52249) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 60341) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2015-09-08 |