| NPI | 1619487386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0005534) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2017-10-06 |