NPI | 1427714492 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 17125) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC LCMHCA-A17125) |
Enumeration Date | 2021-11-13 |
Last Update Date | 2023-06-21 |