| NPI | 1437876687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WV 2667) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AL 4044) |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2022-10-27 |