| NPI | 1255019204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A18951) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: NC 642058) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2023-07-10 |