NPI | 1245601301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014652) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2015-10-15 |
Last Update Date | 2022-10-13 |