NPI | 1609624022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 144510) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA 15609) |
Enumeration Date | 2024-05-09 |
Last Update Date | 2024-05-09 |