| NPI | 1104277821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6799) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA PLPC #6799) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2021-08-10 |