NPI | 1154031714 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 281857) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 281857) |
Enumeration Date | 2022-12-05 |
Last Update Date | 2024-10-04 |