| NPI | 1023406865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO 12904) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2015-01-01 |
| Last Update Date | 2021-10-27 |