NPI | 1568817591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 115094) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 6913) |
Enumeration Date | 2016-04-27 |
Last Update Date | 2022-05-17 |