NPI | 1710371240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8282) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8282) |
Enumeration Date | 2015-03-23 |
Last Update Date | 2025-07-16 |