| NPI | 1699106906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16866) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL 3904) |
| 101YM0800X Counselor, Mental Health (Licence: FL 12159) | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2024-10-29 |