| NPI | 1326599382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MD LC9070) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MD LGP7407) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2021-01-28 |