NPI | 1275158974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: UT 9640257-3902) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 9640257-3904) |
Enumeration Date | 2020-06-09 |
Last Update Date | 2024-08-06 |