| NPI | 1659512275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 413252) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 217985) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2016-08-04 |