| NPI | 1649681479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 9939) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2025-03-20 |