NPI | 1174806434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMFT1612) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
106H00000X Marriage & Family Therapist (Licence: FL IMFT1612) | |
Enumeration Date | 2011-09-23 |
Last Update Date | 2019-08-13 |