| NPI | 1720603640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 7498) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SC 7498) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2021-06-02 |