| NPI | 1578617510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 4585) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4585) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-04-03 |