| NPI | 1881103497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN 2732) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 8669-125) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2023-11-28 |