| NPI | 1093173320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1998) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10788) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2021-02-02 |