| NPI | 1891295192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A13380) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2022-08-11 |