NPI | 1003107129 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3484) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3983) |
Enumeration Date | 2011-04-23 |
Last Update Date | 2024-01-19 |