NPI | 1073689659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 1456) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AK 398) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2022-10-04 |