NPI | 1891842639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 3931) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH 7268) |
Enumeration Date | 2007-01-04 |
Last Update Date | 2007-07-08 |