NPI | 1396290359 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: NC A12369) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12369) |
106H00000X Marriage & Family Therapist (Licence: NC 11057A) | |
Enumeration Date | 2016-08-19 |
Last Update Date | 2016-08-19 |