NPI | 1861135048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 1029-9-15-19-458) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ND 1029-9-15-19-458) |
Enumeration Date | 2022-04-15 |
Last Update Date | 2024-12-18 |