NPI | 1699215798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015647) |
101YP2500X Counselor, Professional (Licence: MI 6401015647) | |
Enumeration Date | 2017-03-08 |
Last Update Date | 2024-08-15 |