| NPI | 1245753441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10404540-6009) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2024-09-27 |