| NPI | 1083437966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11088) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MN 4635) |
| Enumeration Date | 2024-11-07 |
| Last Update Date | 2024-11-07 |