NPI | 1124875976 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451023573) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0021405) |
Enumeration Date | 2024-04-30 |
Last Update Date | 2024-08-07 |