| NPI | 1083383673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO CO.0012791) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8059) |
| 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-49328) | |
| 101YM0800X Counselor, Mental Health (Licence: ME PC5834) | |
| 101YM0800X Counselor, Mental Health (Licence: OR C5747) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-03-24 |