NPI | 1972806776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10168) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-4558) |
Enumeration Date | 2010-12-16 |
Last Update Date | 2023-06-07 |