NPI | 1699953430 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 64441) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 64441) |
Enumeration Date | 2008-02-04 |
Last Update Date | 2015-05-27 |