NPI | 1013112150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5258) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH4573) |
Enumeration Date | 2007-06-19 |
Last Update Date | 2025-09-11 |