NPI | 1770764532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 2203) |
Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC-MH2203) |
Enumeration Date | 2007-11-21 |
Last Update Date | 2024-05-13 |