| NPI | 1760709778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010945) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0201241) |
| 101YM0800X Counselor, Mental Health (Licence: TN 3360) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2024-05-02 |