| NPI | 1366993313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2016008347) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2016008347) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2020-09-15 |