NPI | 1174649610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT50145) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 32906) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2021-10-11 |