NPI | 1023723475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ CSLG12168) |
Enumeration Date | 2023-01-19 |
Last Update Date | 2023-01-19 |