| NPI | 1922104645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0156031) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 3040) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2023-02-28 |