NPI | 1114324167 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112495) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT112495) |
Enumeration Date | 2014-11-19 |
Last Update Date | 2020-01-08 |