| NPI | 1063812899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 88000099A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL4366) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2016-11-08 |