NPI | 1376821074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC49986) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA LPC327) |
Enumeration Date | 2011-07-28 |
Last Update Date | 2014-07-21 |