NPI | 1700407251 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-7671) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 13587780-3902) |
106H00000X Marriage & Family Therapist (Licence: ID 9938) | |
Enumeration Date | 2020-05-06 |
Last Update Date | 2024-02-15 |