NPI | 1710425087 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 3078) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH20181) |
101YM0800X Counselor, Mental Health (Licence: MA 11153) | |
Enumeration Date | 2017-02-07 |
Last Update Date | 2024-09-03 |