NPI | 1487094629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10734) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC010452) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2023-08-29 |