| NPI | 1992820534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12139) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: MA 1151) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2021-03-31 |