| NPI | 1801044516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 57559) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 3786) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2024-03-20 |