| NPI | 1699126136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 6908) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 6417) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2019-07-23 |