NPI | 1063039543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT117554) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT117554) |
Enumeration Date | 2020-06-30 |
Last Update Date | 2022-02-09 |