| NPI | 1205824935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00807) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 0023) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-09-07 |