| NPI | 1740460054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 1089-PA) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2022-08-19 |