NPI | 1942796651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 005818) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8489) |
Enumeration Date | 2018-07-05 |
Last Update Date | 2023-07-24 |