NPI | 1295084648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 122954) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 122954) |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2012-08-30 |
Last Update Date | 2024-06-11 |