NPI | 1225237787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH10014) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00007699) |
Enumeration Date | 2007-07-15 |
Last Update Date | 2015-02-16 |