NPI | 1407277668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC009028) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC004043) |
101YP2500X Counselor, Professional (Licence: GA 009028) | |
Enumeration Date | 2013-12-13 |
Last Update Date | 2022-01-04 |