NPI | 1154079754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717001277) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005603) |
Enumeration Date | 2022-03-13 |
Last Update Date | 2022-03-13 |