NPI | 1104011600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6722) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH4084) |
Enumeration Date | 2007-09-08 |
Last Update Date | 2012-05-18 |