| NPI | 1013532928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7519) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 7519) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2023-10-22 |