| NPI | 1942722970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LGP7904) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC LGPC00256) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2018-03-17 |