| NPI | 1881369627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 14457) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A14457) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-07-19 |