| NPI | 1255840021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11891260-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 086738) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2020-09-08 |