NPI | 1861107062 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020787) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019503) |
Enumeration Date | 2023-01-23 |
Last Update Date | 2024-07-27 |