NPI | 1811049125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LP0001726) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 1726) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2022-06-06 |