NPI | 1720270655 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT79070) |
Additional Taxonomies | 101Y00000X Counselor |
106H00000X Marriage & Family Therapist (Licence: CA IMF 55054) | |
Enumeration Date | 2007-08-14 |
Last Update Date | 2015-11-23 |