| NPI | 1770274086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 9809) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 17895) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-05-17 |