NPI | 1528305588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 9247) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 9247) |
Enumeration Date | 2013-01-10 |
Last Update Date | 2019-08-15 |