| NPI | 1023474418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A12125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 12125) |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2019-06-13 |