NPI | 1063070647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 12905660-6004) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9052) |
Enumeration Date | 2019-05-30 |
Last Update Date | 2024-03-22 |