| NPI | 1437510468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 5980) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 331528) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2016-03-18 |