NPI | 1801447453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11562) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP9749) |
Enumeration Date | 2019-09-25 |
Last Update Date | 2025-04-16 |