| NPI | 1760151245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LA 8026) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: LA PLC8026) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2022-11-22 |