| NPI | 1861694879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 104) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3171) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-12-05 |