NPI | 1801159421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist |
Additional Taxonomies | 101Y00000X Counselor (Licence: OK 1161) |
101YM0800X Counselor Mental Health | |
Enumeration Date | 2012-06-19 |
Last Update Date | 2023-12-13 |