NPI | 1679232185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0020149) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0019089) |
Enumeration Date | 2021-12-12 |
Last Update Date | 2024-11-07 |