NPI | 1790212181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001586) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007831) |
Enumeration Date | 2017-05-16 |
Last Update Date | 2020-02-21 |