| NPI | 1134689466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2019006586) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2019006586) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2019-03-22 |