NPI | 1144653122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0015386) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2013-08-14 |
Last Update Date | 2023-10-26 |