NPI | 1407197577 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC4902) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC4902) |
Enumeration Date | 2013-03-13 |
Last Update Date | 2013-03-13 |