NPI | 1831638857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT130481) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA AMFT97865) |
106H00000X Marriage & Family Therapist (Licence: CA 130481) | |
Enumeration Date | 2017-02-23 |
Last Update Date | 2022-12-13 |