NPI | 1154197820 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 114913) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 114913) |
Enumeration Date | 2023-12-04 |
Last Update Date | 2023-12-04 |