NPI | 1265184196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 130303) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA 130303) |
Enumeration Date | 2022-01-21 |
Last Update Date | 2022-12-26 |