NPI | 1497897664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 481489) |
Additional Taxonomies | 251S00000X (Licence: CA 481489) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2007-07-08 |