NPI | 1225813439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH22754) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MA 6401008731) |
Enumeration Date | 2023-08-28 |
Last Update Date | 2024-04-12 |