NPI | 1396110391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LMFT16179) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA LMFT16179) |
Enumeration Date | 2015-12-02 |
Last Update Date | 2016-04-21 |