| NPI | 1457839797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: HI MHC249) |
| 101YM0800X Counselor Mental Health (Licence: NM CCMH0195201) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |