NPI | 1073795092 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48326) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 12588355-3902) |
106H00000X Marriage & Family Therapist (Licence: ID 8820) | |
106H00000X Marriage & Family Therapist (Licence: OR T2167) | |
Enumeration Date | 2007-11-30 |
Last Update Date | 2022-09-09 |