NPI | 1518953405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPCMH2089) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPC985) |
Enumeration Date | 2005-09-26 |
Last Update Date | 2007-11-16 |