NPI | 1053441725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 1598) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WV 1598) |
101YP2500X Counselor, Professional (Licence: WV 1598) | |
Enumeration Date | 2007-03-06 |
Last Update Date | 2023-06-20 |