NPI | 1255006953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135881) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 17021) |
Enumeration Date | 2021-08-13 |
Last Update Date | 2024-08-16 |