NPI | 1275885113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 117278) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 76826) |
Enumeration Date | 2012-10-02 |
Last Update Date | 2020-09-08 |