NPI | 1629600374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X (Licence: NC 12735) |
Additional Taxonomies | 101Y00000X Counselor (Licence: NC 12735) |
101YM0800X Counselor, Mental Health (Licence: NC 12735) | |
Enumeration Date | 2020-02-11 |
Last Update Date | 2024-03-26 |