NPI | 1831655422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101007162) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401224962) |
Enumeration Date | 2019-02-19 |
Last Update Date | 2025-09-30 |