NPI | 1497453898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 5511) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL ALC04412) |
Enumeration Date | 2023-02-16 |
Last Update Date | 2025-02-04 |