NPI | 1467665828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 339) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MA 609) |
101YM0800X Counselor, Mental Health (Licence: MA 609) | |
Enumeration Date | 2007-05-08 |
Last Update Date | 2025-09-11 |