NPI | 1679761175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 5327) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 1037) |
Enumeration Date | 2007-10-09 |
Last Update Date | 2021-08-30 |