| NPI | 1548579535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LH60634650) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2010032744) |
| Enumeration Date | 2010-09-25 |
| Last Update Date | 2025-02-22 |