NPI | 1407396674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 119602) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 96036) |
Enumeration Date | 2017-03-07 |
Last Update Date | 2022-06-16 |