NPI | 1972147346 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA LPC6027) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA PLC6027) |
Enumeration Date | 2019-10-29 |
Last Update Date | 2023-10-04 |