NPI | 1912516741 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10566) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist |
Enumeration Date | 2020-07-28 |
Last Update Date | 2022-10-26 |