NPI | 1336680040 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401017969) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401015877) |
Enumeration Date | 2017-03-14 |
Last Update Date | 2023-12-28 |