NPI | 1104204593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 115298) |
101Y00000X Counselor | |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2015-05-18 |
Last Update Date | 2020-01-17 |