NPI | 1619323953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401000196) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 6301007553) |
Enumeration Date | 2016-05-05 |
Last Update Date | 2016-05-05 |