NPI | 1902377641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0118746) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VT 097.0113092) |
Enumeration Date | 2018-12-06 |
Last Update Date | 2023-09-18 |