NPI | 1114408002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC8502) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC8502) |
Enumeration Date | 2018-08-28 |
Last Update Date | 2024-01-18 |