| NPI | 1588729990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NH 993) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ME CC3922) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2024-12-04 |