NPI | 1750428975 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 104109) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 104109) |
Enumeration Date | 2007-01-30 |
Last Update Date | 2016-07-04 |