| NPI | 1861979494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: A1711322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P2008051) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2020-08-17 |