NPI | 1801210638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 135584) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
106H00000X Marriage & Family Therapist (Licence: CA 105011) | |
Enumeration Date | 2014-02-13 |
Last Update Date | 2022-11-17 |