NPI | 1740423078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 5890613-6004) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 58906136004) |
Enumeration Date | 2009-04-16 |
Last Update Date | 2022-07-21 |