NPI | 1649960485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW21455) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LCSW133872) |
Enumeration Date | 2023-05-12 |
Last Update Date | 2025-09-26 |