NPI | 1528312576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.007733) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.007733) |
Enumeration Date | 2012-10-30 |
Last Update Date | 2024-03-05 |