NPI | 1407948250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: SC LPC 5054) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC LPC 4930) |
Enumeration Date | 2006-09-29 |
Last Update Date | 2016-01-22 |