| NPI | 1639727241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 111007) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 10201178-3902) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2022-02-11 |