NPI | 1326040346 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SD LMFT#1095) |
Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC#807) |
106H00000X Marriage & Family Therapist (Licence: IA LMFT#00134) | |
Enumeration Date | 2005-08-10 |
Last Update Date | 2025-09-11 |