NPI | 1679915920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-5409) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-3636) |
Enumeration Date | 2013-07-26 |
Last Update Date | 2023-12-04 |