| NPI | 1750895199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 2576) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR A1610132) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2020-08-11 |