| NPI | 1376611459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7087) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2024-08-08 |