NPI | 1528168515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC0014771) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14036) |
Enumeration Date | 2006-09-22 |
Last Update Date | 2024-12-05 |