| NPI | 1013575364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 8650-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 2009) |
| 101YP2500X Counselor, Professional (Licence: WI 8650-125) | |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2024-10-22 |