NPI | 1881838282 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: ID LPC-9530) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-9530) |
101YP2500X Counselor, Professional (Licence: ID LPC-9530) | |
106H00000X Marriage & Family Therapist (Licence: ID LPC-9530) | |
Enumeration Date | 2009-04-29 |
Last Update Date | 2023-06-01 |