NPI | 1124624614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 4464) |
Enumeration Date | 2020-12-09 |
Last Update Date | 2024-11-13 |