| NPI | 1114378908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 6261) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 6724) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2018-01-18 |