NPI | 1780800060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1409) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180-003538) |
Enumeration Date | 2007-04-17 |
Last Update Date | 2007-07-08 |