| NPI | 1538113402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR 961E) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 14579) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2024-02-07 |