NPI | 1780675785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: GA 000279) |
Additional Taxonomies | 101Y00000X Counselor (Licence: GA 000290) |
Enumeration Date | 2005-10-31 |
Last Update Date | 2025-09-11 |