NPI | 1588863047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA LMFT80213) |
106H00000X Marriage & Family Therapist (Licence: CA 57349) | |
Enumeration Date | 2007-07-15 |
Last Update Date | 2022-11-07 |