NPI | 1700204369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.008701) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178.008701) |
Enumeration Date | 2014-04-01 |
Last Update Date | 2014-04-01 |