NPI | 1063702447 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PC005604) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005604) |
Enumeration Date | 2011-04-19 |
Last Update Date | 2024-10-09 |