NPI | 1073763629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 88764) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 60068) |
Enumeration Date | 2008-09-19 |
Last Update Date | 2021-10-27 |