| NPI | 1811595689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 7520) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 7520) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2021-02-16 |