NPI | 1861055360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT119793) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2019-04-19 |
Last Update Date | 2021-09-28 |