NPI | 1003967076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701004274) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ pc00127400) |
Enumeration Date | 2007-01-16 |
Last Update Date | 2007-11-15 |