NPI | 1528577632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.012034) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.012034) |
Enumeration Date | 2017-09-21 |
Last Update Date | 2017-09-21 |