NPI | 1699201913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA MFT1335) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 7125) |
Enumeration Date | 2017-05-05 |
Last Update Date | 2025-07-26 |