| NPI | 1851680433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019778) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 6393) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2024-08-21 |