NPI | 1598463663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 21800) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC21800) |
Enumeration Date | 2023-02-20 |
Last Update Date | 2024-02-21 |