NPI | 1801582440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16259) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC013448) |
Enumeration Date | 2023-04-17 |
Last Update Date | 2023-07-11 |