NPI | 1790158558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH30513) |
Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC20325) |
101YP2500X Counselor, Professional (Licence: SD LPC-MH30513) | |
Enumeration Date | 2015-11-02 |
Last Update Date | 2022-04-07 |