NPI | 1225230097 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0119891) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 9113) |
101YM0800X Counselor, Mental Health (Licence: NC 9113) | |
Enumeration Date | 2007-06-04 |
Last Update Date | 2012-10-15 |