| NPI | 1891049334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0011637) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5047-125) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2022-07-05 |