| NPI | 1629633805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 2488) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2208) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2022-05-08 |