NPI | 1629214911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC S7025) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 7025) |
Enumeration Date | 2008-12-17 |
Last Update Date | 2025-07-15 |