NPI | 1750835047 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15358) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH13995) |
Enumeration Date | 2016-08-04 |
Last Update Date | 2017-10-02 |