NPI | 1023209004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT45320) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC1379) |
Enumeration Date | 2007-08-06 |
Last Update Date | 2016-12-12 |