| NPI | 1083267769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-02-10 |