NPI | 1225522345 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: SC 2805) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 2805) |
Enumeration Date | 2018-06-21 |
Last Update Date | 2023-11-21 |