| NPI | 1215479316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LGP13243) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2022-11-21 |