| NPI | 1013150523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4313) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC00087) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2021-05-05 |