NPI | 1619090446 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9849) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.000532) |
Enumeration Date | 2007-04-08 |
Last Update Date | 2024-07-10 |