| NPI | 1588010664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0183051) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0181121) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2020-10-02 |