| NPI | 1851734263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1860) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001611) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-11-20 |