NPI | 1629611892 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101007435) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF61496958) |
Enumeration Date | 2019-10-21 |
Last Update Date | 2024-04-16 |