NPI | 1003340480 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 99118) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 99118) |
Enumeration Date | 2017-04-12 |
Last Update Date | 2019-02-13 |