NPI | 1629591078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6103) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61001122) |
Enumeration Date | 2017-07-18 |
Last Update Date | 2024-06-04 |