| NPI | 1912989245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM CTB-2022-0209) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 96169) |
| 101YM0800X Counselor, Mental Health (Licence: HI MFT-706) | |
| 163W00000X Registered Nurse (Licence: CA RN423258) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2024-04-25 |