NPI | 1114049749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT52391) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA RN487944) |
Enumeration Date | 2007-04-04 |
Last Update Date | 2014-11-06 |