| NPI | 1649978271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: SC $$$$$$$$$) | |
| 101YM0800X Counselor, Mental Health (Licence: SC 24023359) | |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-02-22 |