NPI | 1316216732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC-6331) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC-6331) |
Enumeration Date | 2011-12-14 |
Last Update Date | 2021-02-08 |