NPI | 1043775109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 81767) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 81767) |
Enumeration Date | 2019-02-04 |
Last Update Date | 2019-02-04 |