| NPI | 1861884363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 10853) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A10853) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2019-06-13 |