| NPI | 1710595038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC12573) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP10533) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2022-04-11 |