NPI | 1376205427 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11515) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC11515) |
Enumeration Date | 2021-10-06 |
Last Update Date | 2024-01-23 |