| NPI | 1265036651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 104100000X Social Worker | |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2020-11-25 |