NPI | 1790042190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT105005) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF70106) |
Enumeration Date | 2012-04-23 |
Last Update Date | 2019-02-11 |