NPI | 1972062438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 11110) |
Additional Taxonomies | 101Y00000X Counselor |
101YP2500X Counselor, Professional | |
106H00000X Marriage & Family Therapist | |
Enumeration Date | 2019-03-14 |
Last Update Date | 2019-03-14 |