| NPI | 1154074029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 17291) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A17291) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-02-08 |