NPI | 1609371103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MA 12288) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2018-03-27 |
Last Update Date | 2021-06-22 |