NPI | 1669910790 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-6488) |
Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC-6488) |
101YM0800X Counselor, Mental Health (Licence: ID LCPC-6488) | |
Enumeration Date | 2017-02-09 |
Last Update Date | 2021-12-03 |