NPI | 1184189789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018044297) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2018044297) |
Enumeration Date | 2019-02-07 |
Last Update Date | 2023-08-22 |