NPI | 1124850383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61665413) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 94726) |
Enumeration Date | 2024-08-16 |
Last Update Date | 2025-06-27 |