| NPI | 1487988713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0169161) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7453) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2024-03-22 |