| NPI | 1760158000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3111) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2771) |
| 106H00000X Marriage & Family Therapist (Licence: CA 124931) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-04-05 |