| NPI | 1891205688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC012810) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DE PC-0001016) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2021-04-06 |