| NPI | 1033769112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 096742) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 11982) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |