| NPI | 1013089689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NH 263) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VT 068.0000600) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-11-09 |