| NPI | 1073680294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AL MASTERS) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AL 4021) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-05-19 |