NPI | 1619739513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MD LGM1007) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGM1007) |
101YM0800X Counselor, Mental Health (Licence: LGM1007) | |
Enumeration Date | 2024-01-25 |
Last Update Date | 2024-01-25 |