NPI | 1629733621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 1629733621) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0017617) |
Enumeration Date | 2021-11-03 |
Last Update Date | 2024-04-18 |