| NPI | 1841726452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2350) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2022-09-21 |