| NPI | 1215554308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC11850) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP9835) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2023-09-26 |