NPI | 1245915651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC12632) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0087400) |
Enumeration Date | 2023-06-21 |
Last Update Date | 2023-06-21 |