| NPI | 1053180828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO 0014578) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO 0021800) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-05-16 |