| NPI | 1003319807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 13607) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A13607) |
| Enumeration Date | 2018-03-18 |
| Last Update Date | 2022-06-14 |