NPI | 1720798903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 11369) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 84907) |
Enumeration Date | 2022-11-29 |
Last Update Date | 2024-03-06 |