NPI | 1659873925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015635) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH16100) |
Enumeration Date | 2018-03-02 |
Last Update Date | 2023-12-29 |