NPI | 1578129680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401222525) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401017141) |
Enumeration Date | 2019-05-14 |
Last Update Date | 2022-06-08 |