| NPI | 1154970648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 15974) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 133337) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2023-09-20 |