NPI | 1760718647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 29912) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 2986) |
Enumeration Date | 2009-10-27 |
Last Update Date | 2009-10-27 |