NPI | 1922420819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 120764) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 76793) |
Enumeration Date | 2014-01-10 |
Last Update Date | 2021-05-11 |