NPI | 1871968297 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31377) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 2895) |
106H00000X Marriage & Family Therapist (Licence: CA 88530) | |
Enumeration Date | 2015-12-10 |
Last Update Date | 2021-06-30 |