| NPI | 1003866021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 5529) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-08-25 |