NPI | 1912205246 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 8460) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701006974) |
101YM0800X Counselor, Mental Health (Licence: NC 8283) | |
Enumeration Date | 2011-03-10 |
Last Update Date | 2022-04-12 |