| NPI | 1255977385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0701010835) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CT 3399) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2021-10-08 |