| NPI | 1982909214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 531) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 531) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2022-09-28 |