NPI | 1386794873 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 3968) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 3968) |
Enumeration Date | 2007-01-10 |
Last Update Date | 2021-03-10 |