| NPI | 1629733621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 1629733621) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0017617) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-04-18 |