| NPI | 1386068526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12064) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2023-02-24 |