| NPI | 1154586550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 4869) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2023-06-12 |