| NPI | 1912205246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 8460) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701006974) |
| 101YM0800X Counselor, Mental Health (Licence: NC 8283) | |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2022-04-12 |