| NPI | 1336767524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-956) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0211821) |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2023-09-18 |