NPI | 1174802599 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT94478) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF 71302) |
Enumeration Date | 2011-08-16 |
Last Update Date | 2019-03-11 |