| NPI | 1295197143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2910) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2711) |
| Enumeration Date | 2016-03-21 |
| Last Update Date | 2023-03-27 |