| NPI | 1891157962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC7996) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP6713) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2017-10-21 |