NPI | 1679786388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15872) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC2042) |
Enumeration Date | 2007-05-08 |
Last Update Date | 2024-08-13 |