NPI | 1154056562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 138747) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 119497) |
Enumeration Date | 2022-07-19 |
Last Update Date | 2024-11-10 |