| NPI | 1558800342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 1567) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NE 2442) |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2021-07-19 |