| NPI | 1538806823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.018032) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 90823) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-01-25 |