| NPI | 1861088023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6801116060) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 68461) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-07-28 |