NPI | 1366775330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA IMF80154) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF80154) |
Enumeration Date | 2009-09-09 |
Last Update Date | 2016-05-17 |