| NPI | 1932488525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 3196) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 3196) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2024-05-24 |