NPI | 1487278982 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23167) |
Additional Taxonomies | 101Y00000X Counselor (Licence: NM CCMH0171851) |
Enumeration Date | 2020-06-01 |
Last Update Date | 2024-10-14 |