| NPI | 1417275884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO 0011639) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR P2007045) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2023-06-06 |