| NPI | 1699459214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 5000766) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 2653) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-12-09 |