NPI | 1083298277 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 2551) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12305A) |
Enumeration Date | 2021-05-12 |
Last Update Date | 2023-05-11 |