NPI | 1376529248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 428) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 1674) |
Enumeration Date | 2005-12-21 |
Last Update Date | 2025-09-11 |