| NPI | 1902449036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 0015802) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO 0015802) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2019-10-30 |