| NPI | 1710320296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10684) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01103) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2025-05-24 |