NPI | 1063560365 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 20572) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN LMFT #834) |
101YM0800X Counselor, Mental Health (Licence: MN MA LP #3316) | |
Enumeration Date | 2007-01-05 |
Last Update Date | 2021-03-10 |