| NPI | 1417608712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 172V00000X) |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-01-18 |