| NPI | 1295263473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7820) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14460) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2020-09-18 |