NPI | 1568750578 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 7350051-6604) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 7350051-6004) |
Enumeration Date | 2011-07-12 |
Last Update Date | 2023-10-12 |