| NPI | 1780828301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C3154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2024-01-03 |