| NPI | 1790845600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0005792) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-09-19 |