| NPI | 1962736702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61537580) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 4410-125) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39002104) | |
| Enumeration Date | 2009-09-27 |
| Last Update Date | 2024-06-11 |