NPI | 1487144184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 268678) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 239987) |
Enumeration Date | 2018-05-17 |
Last Update Date | 2021-10-29 |