| NPI | 1992342760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 095634) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2019-11-29 |
| Last Update Date | 2023-05-25 |