NPI | 1316310253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR P2107012) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012677) |
Enumeration Date | 2015-10-31 |
Last Update Date | 2021-11-29 |