| NPI | 1013496041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 15061) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 009087) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2020-04-23 |