NPI | 1295857019 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 300048) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 001241) |
1041C0700X Social Worker, Clinical (Licence: MO 000327) | |
Enumeration Date | 2007-04-04 |
Last Update Date | 2025-09-11 |