NPI | 1649885617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT120650) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL TPMF620) |
Enumeration Date | 2020-09-15 |
Last Update Date | 2022-10-12 |