NPI | 1992939540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401224685) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH19094) |
Enumeration Date | 2009-05-12 |
Last Update Date | 2025-09-16 |