| NPI | 1740443514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 03130) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001043) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2022-02-12 |