NPI | 1215454202 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: NC 13230) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 13230) |
Enumeration Date | 2017-08-29 |
Last Update Date | 2022-05-16 |