NPI | 1487030862 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 136036) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA AMFT86176) |
106H00000X Marriage & Family Therapist (Licence: CA AMFT125194) | |
Enumeration Date | 2015-08-07 |
Last Update Date | 2023-01-10 |