NPI | 1992838114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT3078) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC45) |
Enumeration Date | 2007-03-14 |
Last Update Date | 2025-09-11 |