| NPI | 1376769513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TN LPN39171) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-09-30 |