| NPI | 1962030148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC A15650) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A15650) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2020-06-15 |