NPI | 1962951004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-19450) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI MHC-613) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2016-09-30 |
Last Update Date | 2023-12-01 |