| NPI | 1922509694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NY 009471) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH61204561) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2022-07-12 |