NPI | 1265451843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2001025351) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2001025351) |
Enumeration Date | 2006-07-18 |
Last Update Date | 2020-03-31 |