| NPI | 1063112597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6312-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 6312-125) |
| 101YM0800X Counselor, Mental Health (Licence: WI 6312-125) | |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |