NPI | 1386069565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 30907) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 101101) |
101YM0800X Counselor, Mental Health (Licence: NE 2448) | |
Enumeration Date | 2014-02-25 |
Last Update Date | 2025-02-03 |