| NPI | 1023824265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LPC-8879) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-8879) |
| 225C00000X Rehabilitation Counselor (Licence: 445968) | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2024-12-03 |