NPI | 1164083028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA ACSW89188) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2019-06-21 |
Last Update Date | 2022-02-01 |