| NPI | 1073049557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0188251) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM CMH0188251) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2023-09-12 |