NPI | 1215690250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 126621) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT126621) |
Enumeration Date | 2021-10-18 |
Last Update Date | 2023-07-03 |