| NPI | 1871516286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2005028641) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-07-27 |