| NPI | 1710526736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2024-04-03 |