NPI | 1881007672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA 35901) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 3198) |
106H00000X Marriage & Family Therapist (Licence: WI 1031-124) | |
Enumeration Date | 2014-06-09 |
Last Update Date | 2025-06-21 |