NPI | 1134684335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT123851) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT110915) |
Enumeration Date | 2019-02-01 |
Last Update Date | 2021-01-21 |