NPI | 1912155912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17611) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL C1505A) |
Enumeration Date | 2008-09-03 |
Last Update Date | 2020-01-29 |