NPI | 1871966150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 11786) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701012486) |
101YP2500X Counselor, Professional (Licence: AL 04767) | |
Enumeration Date | 2015-11-09 |
Last Update Date | 2023-10-02 |