| NPI | 1215490966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 14556) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A14556) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-08-23 |