| NPI | 1982087706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A11537) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 11537) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-02-07 |