NPI | 1154674299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT126140) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 90611) |
106H00000X Marriage & Family Therapist (Licence: CA 126140) | |
Enumeration Date | 2012-10-25 |
Last Update Date | 2021-12-21 |