NPI | 1639678485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT130447) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT109338) |
Enumeration Date | 2018-02-07 |
Last Update Date | 2022-07-21 |