NPI | 1821507161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0014791) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014791) |
Enumeration Date | 2017-09-28 |
Last Update Date | 2019-01-29 |