NPI | 1407126139 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 108727) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
106H00000X Marriage & Family Therapist | |
106H00000X Marriage & Family Therapist (Licence: CA 74215) | |
Enumeration Date | 2012-01-11 |
Last Update Date | 2019-10-24 |