NPI | 1285160796 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 113179) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 98621) |
Enumeration Date | 2017-05-03 |
Last Update Date | 2019-09-28 |