NPI | 1396862744 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC004855) |
Additional Taxonomies | 101Y00000X Counselor (Licence: GA LPC004855) |
Enumeration Date | 2007-03-23 |
Last Update Date | 2017-03-13 |