| NPI | 1154965879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 15353) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A15353) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2022-06-13 |