NPI | 1629574090 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60822202) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 6489) |
101YM0800X Counselor, Mental Health (Licence: LA 1291) | |
Enumeration Date | 2018-04-03 |
Last Update Date | 2019-06-11 |