NPI | 1053842021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A12845) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12845) |
106H00000X Marriage & Family Therapist (Licence: NC A12845) | |
Enumeration Date | 2017-03-22 |
Last Update Date | 2024-03-07 |