NPI | 1043525033 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC0018179) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60625261) |
101YP2500X Counselor, Professional (Licence: TX 64590) | |
Enumeration Date | 2010-08-13 |
Last Update Date | 2022-05-06 |