| NPI | 1942662606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2919) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5022) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-01-12 |