| NPI | 1942930771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ND 124510122A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0019609) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-12-29 |