NPI | 1093923609 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 00198) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPC547) |
106H00000X Marriage & Family Therapist (Licence: SD LMFT1148) | |
Enumeration Date | 2007-05-18 |
Last Update Date | 2025-09-11 |