NPI | 1154540714 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT111561) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 75042) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2019-04-04 |