| NPI | 1245982271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3558) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 12779) |
| Enumeration Date | 2022-01-20 |
| Last Update Date | 2024-01-10 |