NPI | 1093053506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT103991) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301014421) |
Enumeration Date | 2013-01-18 |
Last Update Date | 2019-03-16 |