NPI | 1609920420 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701004334) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0701004334) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2021-11-18 |