NPI | 1013418961 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT105124) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 105124) |
Enumeration Date | 2018-02-26 |
Last Update Date | 2018-12-12 |