NPI | 1609417450 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 283015) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 260120) |
Enumeration Date | 2019-10-02 |
Last Update Date | 2024-03-19 |