| NPI | 1265651202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 5559) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0082551) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2023-09-06 |