| NPI | 1902985179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 3674) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3674125) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2024-07-30 |