| NPI | 1982304689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 0732939794) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-19 |