| NPI | 1487984241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 10450) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2019-10-24 |