| NPI | 1508413287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 98002878A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC015002) |
| 101YM0800X Counselor, Mental Health (Licence: OH E.2202961) | |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-04-30 |