| NPI | 1134750979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 14192) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12026) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2024-11-22 |