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 |