NPI | 1558786483 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A9643) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A9643) |
Enumeration Date | 2014-03-01 |
Last Update Date | 2014-08-25 |