NPI | 1457879710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH20391) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SD LPC20348) |
Enumeration Date | 2017-09-06 |
Last Update Date | 2022-06-13 |