| NPI | 1609017953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA LPC006313) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2024-03-22 |