NPI | 1295876910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC004404) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701005594) |
Enumeration Date | 2007-02-08 |
Last Update Date | 2022-07-21 |