NPI | 1407338379 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA LPCC7234) |
Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-17011) |
Enumeration Date | 2018-09-06 |
Last Update Date | 2019-11-26 |