NPI | 1073168530 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7115) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C7115) |
Enumeration Date | 2019-08-01 |
Last Update Date | 2024-11-17 |