NPI | 1376505347 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 173) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1728) |
101YP2500X Counselor, Professional (Licence: NC 3020) | |
Enumeration Date | 2006-04-05 |
Last Update Date | 2025-09-11 |