NPI | 1114138823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL LPC 1177) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL NCC 34447) |
Enumeration Date | 2007-05-24 |
Last Update Date | 2007-07-08 |