NPI | 1548665052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 46.003756) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YP2500X Counselor, Professional | |
261QP2300X Clinic/Center, Primary Care (Licence: CT 3756) | |
Enumeration Date | 2014-10-27 |
Last Update Date | 2022-04-01 |