NPI | 1912269838 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC-6532) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6532) |
Enumeration Date | 2012-06-15 |
Last Update Date | 2018-12-11 |