| NPI | 1063979193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8380) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA C.1901746) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2024-08-23 |