| NPI | 1174865935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10036) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A10036) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-09-23 |