NPI | 1104668151 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0016944) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC0016944) |
101YP2500X Counselor, Professional | |
Enumeration Date | 2024-06-11 |
Last Update Date | 2025-09-12 |