| NPI | 1467064972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA LMHC10002001) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: RI MHC01717) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-08-15 |