| NPI | 1902285786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0173811) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO CS001384) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2015-05-26 |