| NPI | 1699218446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR C6690) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2022-09-12 |