| NPI | 1144991142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 16137) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A16137) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2023-07-07 |