NPI | 1649780719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0013886) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0013886) |
Enumeration Date | 2017-10-03 |
Last Update Date | 2022-08-25 |