| NPI | 1154949170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15789) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15789) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2023-12-05 |