NPI | 1477802171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT132596) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA IMF98796) |
101YM0800X Counselor, Mental Health (Licence: CA IMF98796) | |
Enumeration Date | 2012-09-10 |
Last Update Date | 2022-06-06 |