NPI | 1194272286 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 126444) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 126444) |
Enumeration Date | 2016-09-06 |
Last Update Date | 2021-07-14 |