| NPI | 1154945632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA LMHC10001764) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 16190) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2024-05-07 |