| NPI | 1588999379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 46-2903208) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1442) |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2022-01-18 |