NPI | 1467878173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA lMF 72130) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF72130) |
Enumeration Date | 2014-03-05 |
Last Update Date | 2020-03-27 |