NPI | 1649647561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH-60986600) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-22498) |
101YM0800X Counselor, Mental Health (Licence: ID LCPC-9675) | |
Enumeration Date | 2015-08-26 |
Last Update Date | 2024-01-04 |